Lutetium LU 177 dotatate (Lutathera®)

How to Take Lutetium LU 177 dotatate (Lutathera®)

This medication is given by IV (into a vein). Because it contains a small amount of radiation, this medication is given by a nuclear medicine specialist. The amount of medication given is based on the size of your body. The amount of radiation given will be monitored by your team. You will also receive amino acids by IV to protect your kidneys as part of your treatment.

Stop taking any long-acting form of octreotide you are taking 4 weeks before being treated with lutetium LU 177 dotatate (Lutathera®). If you are taking short-acting octreotide, you should stop this at least 24 hours before getting lutetium LU 177 dotatate (Lutathera®). After you receive this medication, you will be given long-acting octreotide.

Radiation can be present in excreted in bodily fluids for a few days after you have this treatment. You should take proper safety precautions to protect other people in your home. Your provider will provide you with radiation safety precautions.

Possible Side Effects of Lutetium LU 177 dotatate (Lutathera®)

There are many things you can do to manage the side effects of lutetium LU 177 dotatate.  Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bathe daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your oncology care team before scheduling dental appointments or procedures.
• Ask your oncology care team before you, or someone you live with has any vaccinations.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your oncology care team know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.

• Do not use a razor (an electric razor is fine).
• Avoid contact sports and activities that can result in injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), etc. as these can all increase the risk of bleeding. Please consult with your healthcare team regarding the use of these agents and all over the counter medications/supplements while on therapy.
• Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Kidney Problems

This medication can cause kidney problems, including an increased creatinine level, which your care team may monitor for using blood tests. Notify your healthcare provider if you notice decreased urine output, blood in the urine, swelling in the ankles, or loss of appetite.

Liver Toxicity

This medication can cause liver toxicity, which your doctor may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown or pain in your abdomen, as these can be signs of liver toxicity.

Nausea/Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy, or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.

Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Decrease in Appetite or Taste Changes

 Nutrition is an important part of your care. Cancer treatment can affect your appetite, and in some cases, the side effects of treatment can make eating difficult. Ask your oncology care team about nutritional counseling services at your treatment center to help with food choices. Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals. If you are not eating enough, nutritional supplements may help.

You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.

Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products, and fish without a strong smell. Sometimes cold food has less of an odor.

Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce, or dressings. Use seasonings like basil, oregano, or rosemary to add flavor. Bacon, ham, and onion can add flavor to vegetables.

Important but less common side effects

• Secondary cancers: A secondary cancer develops as a result of cancer treatment for another cancer. This is rare, but you should be aware of the risk. In most cases, a secondary cancer related to this treatment is leukemia or myelodysplastic syndrome. This can occur years after treatment. Your provider will monitor your labs closely. Consider having a complete blood count with differential checked annually by your healthcare provider if you received high-risk therapies.
• Neuroendocrine hormonal crisis: In rare cases, this medication can cause a sudden release of hormones (like serotonin) from the tumor into the blood stream. This can cause severe flushing, diarrhea, and low blood pressure. Your care team with watch you closely for this side effect and provide support care as necessary including octreotide, iv fluids, steroids and electrolytes. This is a medical emergency and would require immediate medical assistance.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 7 months after treatment for women and 4 months after treatment for men. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive.

This medication can affect fertility and future ability to become pregnant. It can also cause lower sperm counts in men and may affect the ability to father a child. Talk with your healthcare provider about fertility preservation options. You should not breastfeed while receiving this medication or for at least 2.5 months after your last dose.